Document Type : Original Article


1 Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Food Technology, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Epidemiology and Biostatistics, Endocrinology and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Health, Almahdi University, Isfahan, Iran


Objective: This study was designed to compare the efficacy and safety of enteral 
supplementation of a prebiotic mixture (SCGOS/LCFOS) on faecal microbiota in very 
premature infants who fed exclusively with human-milk.
Methods: This double‑center randomized control trial was conducted from December 
2012 to November 2013 in the tertiary Neonatal Intensive Care Units of the Isfahan 
University of Medical Sciences. Fifty preterm infants (birth weight ≤1500 g who 
were not fed with formula) were randomly allocated to have enteral (tube feeding) 
supplementation with a prebiotic mixture (SCGOS/LCFOS; 9:1) or receive no prebiotics.
Findings: The primary outcome (e.g., the effect of the prebiotic mixture on fecal 
microbiota pattern) was clearly different between the two groups. Despite greater 
coliforms colony counts in first stool cultures in the prebiotic group (Group P)(P = 0.67), 
coliforms were significantly lower in the third stool cultures in the Group P (P < 0.001). 
Furthermore, despite the much higher Lactobacillus colony counts, in the first 
stool cultures, in the control group (Group C) (P = 0.005); there was a trend toward 
significantly increased Lactobacillus colony counts in the Group P during the study, 
but the difference between Lactobacillus colony counts, in the third stool cultures, 
between two groups was no longer statistically significant(P = 0.11). Interestingly, the 
median length of hospital stay was significantly less in the Group P (16 [12.50–23.50] 
vs. 25 [19.50–33.00] days; P = 0.003).
Conclusion: This suggests that it might have been “the complete removal of formula” which 
manifests a synergistic effect between nonhuman neutral oligosaccharides (prebiotics) 
and human oligosaccharides, which in turn, led to the rapid growth of beneficial 
Lactobacillus colonies in the gut of breast milk‑fed preterm infants, while decreasing 
the number of pathogenic coliforms microorganisms. Therefore, further studies with 
larger sample sizes are recommended to investigate the issue.


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